Lung Adenocarcinoma with K-RAS - 1258661

I don't think there has ever been anything presented or published about benefit of anti-PD1 being more or less in patients with KRAS mutations, EGFR mutation, or any other molecular marker. To my knowledge, there is no reason to think that someone with a KRAS mutation should be less likely to benefit than anyone else. It should not be an exclusion criterion.

The main class of targeted therapies that are being studied as being focused largely on patients with a KRAS mutation are MEK inhibitors like selumetinib, which is the subject of a phase III trial just being activated globally, giving Taxotere (docetaxel) with or without selumetinib as second line therapy to patients with a KRAS mutation.

Good luck.

-Dr. West

Trying to follow guidelines; new at this. I have Stage IV BAC, K-RAS mutation. Most literature indicates KRAS not helped by Tarceva. Have had chemo & Avastin beginning March 2013. All lobes have diffuse markings with growing area in LL lobe. Oncologist is ready to put me on Tarceva, although he admits it is a very slim chance of helping (He calls this maintenance.).. Should I not get on a lung transplant list? I cannot see any hope of living otherwise. I am a 61 yo female in fairly good health, treated by same primary care physician for roughly a dozen years for bronchitises and pneumonias. Imagine my shock when we finally did a CT scan.
Sherilyn

Sherilyn,

Lung transplants are almost never done on people with metastatic lung cancer, since there is no actual evidence that they help patients live longer (metastatic cancer can travel through the bloodstream, so the cancer can pop up in the liver 2 days after the transplant surgery), they're extraordinarily expensive, and very risky, so I think your chances of getting a lung transplant are far lower than your chance of benefiting on Tarceva (erlotinib). They have occasionally been done on patients with BAC, but there is no actual high quality evidence that people do better than they would have done without the surgery. There is no long-term outcome data that suggests anyone is cured with a lung transplant.

The evidence about people with KRAS mutations shows that they benefit the same as other patients who don't have an EGFR mutation. The guidelines are written by people who have their own biases, and frankly the recommendations against EGFR TKIs for people with KRAS mutations are based on some strong-willed people who are propagating their biased views rather than actually following what the evidence shows. This isn't to say that there is likely to be a major benefit from Tarceva in someone with a KRAS mutation, but there isn't likely to be a major benefit from Tarceva in anyone who doesn't have an EGFR mutation, whether they have a KRAS mutation or not...but sometimes that prediction is wrong. And there aren't necessarily much better alternatives, though maintenance Alimta (pemetrexed) is often a strong consideration and is likely to be among the more effective agents for bronchioloalveolar carcinoma (BAC). Moreover, there is even some (weak) evidence that Alimta may be particularly effective for NSCLC that has a KRAS mutation.

Good luck.

-Dr. West

Thank you so very much for your quick reply. I am familiar with no transplant because of lung ca mets, which is why some transplant teams are doing it for BAC, since it does not mets. If I have the wrong info on this, please let me know.

Best regards,

Sherilyn

sherilyn, We have a lot written about BAC on Grace as well Dr. West is tops in the field of BAC and he's written quite a bit here and elsewhere.

Below is a link to many of our blog posts on BAC, however none suggest transplant, as a matter of fact transplant isn't something normally recommended with lung cancer at all.

I hope it 's helpful.
http://cancergrace.org/lung/category/lung-cancer/core-concepts/bronchio…

Janine

There are some transplant teams that are doing this. There is no evidence that it is an effective long term strategy, and it is not a standard treatment.

-Dr. West